<?php
	$this->title('Add Physical Symptom Entry');
?>

<h3><?=$this->title();?></h3>

<?=$this->form->create($physicalSymptomAnswer);?>
<?=$this->form->label('Patient');?>
<?php 
	$patientCollection = array();
	foreach ($patients as $patient) {
		$patientCollection[$patient->id] = $patient->PatID;
	}
?>
<?=$this->form->select('patient_id', $patientCollection);?>
<?=$this->form->label('Arthiritis/Joint Pain/Stiffness');?>
<?=$this->form->select('qnumber1', array('NA' => 'NA', 'Yes' => 'Yes', 'No' => 'No'));?>
<?=$this->form->label('Fatigue');?>
<?=$this->form->select('qnumber2', array('NA' => 'NA', 'Yes' => 'Yes', 'No' => 'No'));?>
<?=$this->form->label('Flu-like Symptoms');?>
<?=$this->form->select('qnumber3', array('NA' => 'NA', 'Yes' => 'Yes', 'No' => 'No'));?>
<?=$this->form->label('Dizziness');?>
<?=$this->form->select('qnumber4', array('NA' => 'NA', 'Yes' => 'Yes', 'No' => 'No'));?>
<?=$this->form->label('Headaches');?>
<?=$this->form->select('qnumber5', array('NA' => 'NA', 'Yes' => 'Yes', 'No' => 'No'));?>
<?=$this->form->label('Heart Palpitations');?>
<?=$this->form->select('qnumber6', array('NA' => 'NA', 'Yes' => 'Yes', 'No' => 'No'));?>
<?=$this->form->label('Muscle Pain and/or Numbness or Tingling');?>
<?=$this->form->select('qnumber7', array('NA' => 'NA', 'Yes' => 'Yes', 'No' => 'No'));?>
<?=$this->form->label('Muscle Weakness');?>
<?=$this->form->select('qnumber8', array('NA' => 'NA', 'Yes' => 'Yes', 'No' => 'No'));?>
<?=$this->form->label('Bell\'s Palsy');?>
<?=$this->form->select('qnumber9', array('NA' => 'NA', 'Yes' => 'Yes', 'No' => 'No'));?>
<?=$this->form->label('Meningitis');?>
<?=$this->form->select('qnumber10', array('NA' => 'NA', 'Yes' => 'Yes', 'No' => 'No'));?>
<?=$this->form->label('Seizures');?>
<?=$this->form->select('qnumber11', array('NA' => 'NA', 'Yes' => 'Yes', 'No' => 'No'));?>
<?=$this->form->label('Sweats');?>
<?=$this->form->select('qnumber12', array('NA' => 'NA', 'Yes' => 'Yes', 'No' => 'No'));?>
<?=$this->form->label('Neck Creaking');?>
<?=$this->form->select('qnumber13', array('NA' => 'NA', 'Yes' => 'Yes', 'No' => 'No'));?>
<?=$this->form->label('Tinnitis');?>
<?=$this->form->select('qnumber14', array('NA' => 'NA', 'Yes' => 'Yes', 'No' => 'No'));?>
<?=$this->form->label('Sleep Disturbances');?>
<?=$this->form->select('qnumber15', array('NA' => 'NA', 'Yes' => 'Yes', 'No' => 'No'));?>
<?=$this->form->label('Weight');?>
<?=$this->form->select('qnumber16', array('NA' => 'NA', 'Low' => 'Low', 'Obese' => 'Obese', 'Normal' => 'Normal'), array('value' => 'Normal'));?>
<?=$this->form->label('Global Symptom Rating');?>
<?=$this->form->select('qnumber17', array('NA' => 'NA', 'Better' => 'Better', 'Same' => 'Same', 'Worse' => 'Worse'));?>
<?=$this->form->field('record_date', array('label' => 'Date Given'));?>
<?=$this->form->submit('Save'); ?>
<?=$this->form->end();?>